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Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Thomas R. Talbot ,
James G. Johnson ,
Claudette Fergus ,
John Henry Domenico ,
William Schaffner ,
Titus L. Daniels ,
Greg Wilson ,
Jennifer Slayton ,
Nancye Feistritzer  and
Gerald B. Hickson
Thomas R. Talbot*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
James G. Johnson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
Claudette Fergus
Affiliation:
Vanderbilt University Medical Center, Nashville, Tennessee
John Henry Domenico
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
William Schaffner
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Greg Wilson
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
Jennifer Slayton
Affiliation:
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
Nancye Feistritzer
Affiliation:
Vanderbilt University Medical Center, Nashville, Tennessee
Gerald B. Hickson
Affiliation:
Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
*
Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Diseases, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232 ([email protected])
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Abstract

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Objective.

To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence.

Design.

Time-series design with correlation analysis.

Setting.

Tertiary care academic medical center, including outpatient clinics and procedural areas.

Participants.

Medical center healthcare personnel.

Methods.

A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection.

Results.

A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P<.0001) as well as from one phase to the next (P < .0001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R2 = 0.70).

Conclusions.

Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 11 , November 2013 , pp. 1129 - 1136
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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